Community-based health coverage at the crossroad: The Muhammadiyah health fund in Indonesia

Abstract

This paper discusses the complexities of community-based health insurance (CBHI) coordinated by faith-based NGOs in Indonesia, and how government health care schemes threaten community-based health care plans. A qualitative approach with a deep interview followed by a field visit and using secondary data for analysis, this study particularly look inside into Muhammadiyah’s history, one of the largest Islamic civil society organizations dealing with the health sector, as well as their struggle to facilitate community-based health care insurance. Muhammadiyah established Dana Sehat Muhammadiyah (Muhammadiyah Health Fund) to provide internal insurance for students. It was growing rapidly during 2000-2016. However, after the new regulation applied in 2014 the progress was slowed down and became conflicting. The role of state-based universal health coverage (UHC) has markedly overshadowed civil society programs, including faith-based NGOs, in implementing and providing health care services in their circles or members. While the State faces a delicate situation in the management of its universal health care, both financially and operationally, civil society groups have sought to revive the limited health care scheme as a way to supplement and even contend with the state welfare regime. However, during this pandemic situation MHF can be an alternative solution to support UHC. Tulisan ini membahas kompleksitas asuransi kesehatan berbasis komunitas (CBHI) yang dikoordinasikan oleh Ormas berbasis agama di Indonesia, dan bagaimana skema perawatan kesehatan pemerintah mengancam rencana perawatan kesehatan berbasis komunitas. Pendekatan kualitatif dengan wawancara mendalam disertai kunjungan lapangan serta data sekunder, secara khusus membahas tentang sejarah Muhammadiyah, salah satu organisasi masyarakat sipil Islam terbesar yang bergerak di bidang kesehatan, serta perjuangan mereka memfasilitasi jaminan kesehatan berbasis masyarakat. Muhammadiyah mendirikan Dana Sehat Muhammadiyah (DSM) yang berkembang dengan pesat di era 2000-2016. Akan tetapi dengan berlakunya aturan baru tahun 2014 perkembangannya terhambat dan menurun. Peran jaminan kesehatan universal (UHC) berbasis negara telah menghilangkan program asuransi kesehatan masyarakat sipil, termasuk Ormas berbasis agama, dalam melaksanakan dan menyediakan layanan perawatan kesehatan di lingkungan atau anggotanya. Sementara negara menghadapi situasi yang rumit dalam pengelolaan perawatan kesehatan universal, baik secara finansial maupun operasional, kelompok masyarakat sipil telah berusaha untuk menghidupkan kembali skema perawatan kesehatan yang terbatas sebagai cara untuk melengkapi dan bahkan bersaing dengan rezim kesejahteraan negara. Dalam situasi pandemi model DSM menjadi salah satu solusi alternatif dalam mendukung UHC.